維基百科

自殺

(由自盡跳轉過嚟)

自殺係夾硬結束自己生命嘅行為。響好多宗教中，自殺係罪，有啲國家嘅法律禁止自殺或協助他人自殺。有啲國家嘅文化當中，自殺係榮譽，喺面臨恥辱同埋兩難不可解嘅情境時選擇自殺，往往能夠得到相當嘅尊敬。有心理疾病或者衝動都係自殺嘅風險因素[1][2][3]。

台灣新北市一塊預防自殺嘅牌
侍表演劏肚（日本一種自殺儀式）

自殺大部分係指人結束自己生命嘅行為，但喺其他動物上亦有呢個行為，世界各地曾經多次發現鯨魚同埋海豚喺海灘擱淺，佢哋被人送返落海之後，又掉頭返海灘，最終死亡，唔知點解。

有啲自殺係由壓力（例如財政或者學業困難）、人際關係問題（例如分手或者離婚）、或者騷擾同欺凌引起嘅衝動行為。[4][5][6] 以前曾經嘗試自殺嘅人，再次嘗試自殺嘅風險會高啲。[4] 有效嘅預防自殺工作包括限制攞到自殺工具嘅途徑，例如槍械、藥物同毒藥；治療精神障礙同藥物濫用；小心處理大眾傳媒對自殺嘅報導；改善經濟狀況；[4][7] 同埋辯證行為療法（DBT）。[8] 雖然危機熱線，例如北美洲嘅988電話號碼同澳洲嘅生命熱線，係常見嘅求助資源，但佢哋有幾有效就仲未研究得好清楚。[9][10]

自殺係全球第十大主要死因，[11][12] 約佔總死亡人數嘅 1.5%。[13] 每年嚟計，大約係每十萬人有 12 個。[12] 雖然 2015 年全球有 828,000 人死於自殺，比起 1990 年嘅 712,000 人增加咗，但按年齡調整過嘅死亡率下降咗 23.3%。[14][15] 按性別計，男性自殺率普遍高過女性，由發展中國家嘅 1.5 倍到發達國家嘅 3.5 倍不等；喺西方世界，冇死到嘅自殺未遂喺年輕人同女性當中比較常見。[16] 自殺通常喺 70 歲以上嘅人度最常見；不過，喺某啲國家，年齡介乎 15 至 30 歲嘅人風險最高。[17] 2015年，歐洲係各個區域裏面自殺率最高嘅地方。[18] 估計每年有 1000 萬到 2000 萬單冇死到嘅自殺未遂。[19] 冇死到嘅自殺未遂可能會令人受傷同埋有長期傷殘。[16] 最常用嘅自殺方法因國家而異，部分同容唔容易攞到啲有效方法有關。[20] 協助自殺，有時係喺個人受緊劇痛或者就快死嗰陣做嘅，喺好多國家都係合法，而且數字越嚟越多。[21][22]


對自殺嘅睇法一直受到廣泛嘅存在主義課題影響，例如宗教、榮譽同生命意義。[23][24] 亞伯拉罕諸教傳統上認為自殺係對上帝嘅罪，因為佢哋相信生命神聖。[25] 喺日本武士時代，一種叫做切腹（腹切り，harakiri）嘅自殺方式受到尊重，作為彌補過失或者一種抗議方式。[26] 自殺同自殺未遂，雖然以前係犯法嘅，但喺大多數西方國家已經唔再係。[27] 喺某啲國家，自殺仍然係刑事罪行。[28] 喺 20 同 21 世紀，自殺喺好少情況下會用嚟做抗議嘅一種形式；亦都有喺謀殺緊人或者謀殺完人之後自殺嘅情況，呢種策略軍事上同恐怖分子都有用過。[29] 自殺通常畀人睇成係一場大災難，令死者嘅親人、朋友同社區成員非常傷痛，而且喺全世界幾乎所有地方都畀人睇得好負面。[30][31]

定義

編輯
内文：自殺術語

自殺，嚟自拉丁文 suicidium，係「攞自己條命嘅行為」。[32][33] 自殺未遂，或者叫冇死到嘅自殺行為，算係自殘，起碼有少少想死嘅念頭，但最後冇死到。[34][35] 協助自殺係指一個人透過提供建議或者工具，間接幫另一個人自殺。[36] 安樂死，再具體啲講係自願安樂死，就係指另一個人更加主動去令一個人死亡。[36]

自殺意念係指有想死嘅念頭，但冇實際去做。[34] 呢啲念頭可能涉及，亦可能唔涉及確實嘅計劃或意圖。[35] 自殺傾向定義為「自殺嘅風險，通常睇到有自殺念頭或者意圖就知，特別係當有周詳嘅自殺計劃嗰陣就更加明顯。」[37]

喺謀殺後自殺（或殺人後自殺）入面，個人嘅目標係同時攞埋其他人條命。呢樣嘢有個特別情況叫擴大自殺，即係謀殺嘅動機係因為佢覺得被殺嗰啲人係自己嘅一部分。[38] 因為個人覺得自己同社會格格不入而自殺嘅，就叫做利己主義自殺。[39]

加拿大自殺預防中心發現，學術研究同新聞報導描述自殺行為，常用嘅動詞係「commit」，並主張要用去污名化嘅自殺相關術語；喺 2011 年，佢哋發表咗一篇題為「自殺與語言：點解我哋唔應該用『C』字頭嘅詞」嘅文章，呼籲改變講自殺嗰陣用嘅字眼。[40][41] 美國心理學會將「committed suicide」（犯下自殺）列為應該避免用嘅術語，因為佢「將自殺定性犯罪」。[42] 一啲倡議團體建議用「結束咗自己嘅生命」、「死於自殺」或者「殺死咗自己」呢啲講法，而唔用「犯下自殺」。[43][44][45] 美聯社格式手冊建議避免用「committed suicide」，除非係直接引用官方講法。[46] 《衛報》同《觀察家報》嘅格式指南都棄用咗「committed」呢個字眼，[47] CNN都係咁做。[48] 反對用「commit」嘅人認為，呢個詞暗示自殺係犯法、有罪，或者道德上係錯嘅。[49]

病理生理學

編輯
 
BDNF - 腦源性神經營養因子 (紫色) 同 NT-4 異二聚體 (藍色).

目前仲未搵到統一嘅潛在病理生理學去解釋自殺；[16] 一般認為自殺係行為、社會經濟同心理因素互相影響嘅結果。[20] 低水平嘅腦源性神經營養因子（BDNF）同自殺直接有關，[50] 亦都因為佢喺重度抑鬱症、創傷後壓力症候群、精神分裂症同強迫症嘅作用而間接有關。[51] 驗屍研究發現，無論有冇精神病患，死者嘅海馬體同前額葉皮層嘅 BDNF 水平都比較低。[52] 血清素，一種腦部神經傳遞素，一般認為喺自殺死咗嘅人體內水平會低啲。[53] 部分證據係嚟自死後發現5-HT2A受體水平增加咗。[54] 其他證據包括喺腦脊液裏面發現血清素分解產物5-羥基吲哚乙酸水平低咗。[55] 不過，好難攞到直接證據。[54] 表觀遺傳學，研究因應環境因素而改變基因表達（但唔改變底層DNA）嘅學科，亦都畀人認為對決定自殺風險有一定影響。[56]

風險因素

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美國2017年嘅誘發情況[57]
類別 百分比
確診精神問題
  
 50%
近期或就快有危機
  
 31%
親密伴侶問題
  
 27%
身體健康問題
  
 21%
酒精問題
  
 18%
藥物濫用（酒精除外）
  
 18%
爭執
  
 16%
家庭問題
  
 10%
工作問題
  
 10%
錢銀問題
  
 9%
法律問題
  
 8%
親人過身
  
 7%
自殺係多因素引起嘅。同一個人可能同時有多種誘發情況同風險因素。

影響自殺風險嘅因素包括精神障礙、藥物濫用、心理狀態、文化、家庭同社會狀況、遺傳、經歷創傷或者失去親友，同埋虛無主義。[58][59][10] 精神障礙同藥物濫用經常一齊出現。[60] 其他風險因素包括以前試過自殺、[16] 容易攞到自殺嘅工具、屋企有人自殺過，或者有創傷性腦損傷。[61] 例如，研究發現屋企有槍械嘅家庭，自殺率高過冇槍嘅家庭。[62]

社會經濟問題，例如失業、貧窮、無家可歸同歧視，都可能引發自殺念頭。[63][64] 喺社會凝聚力高、道德上反對自殺嘅社會，自殺可能比較少見。[35] 遺傳因素似乎解釋咗 38% 到 55% 嘅自殺行為。[65] 自殺亦都可能喺某啲地區集中出現。[66]

大多數研究冇區分引致自殺念頭嘅風險因素同引致自殺未遂嘅風險因素。[67][68] 自殺未遂（唔單止係有自殺念頭）嘅風險因素包括高痛閾同埋冇咁驚死。[69]

自閉症

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内文：自閉症 § 自殘與自殺

自閉症患者諗同試自殺嘅次數比一般人多。[70] 研究發現自閉症人士嘗試自殺嘅可能性比非自閉症人士高達七倍。[71][唔該解釋係乜東東]

環境暴露

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睇埋：腦部健康與污染

某啲環境暴露因素，包括空氣污染、日照強度、日照時間、熱浪、酷熱天氣同高海拔，都同自殺有關。[72] 短期接觸PM10同自殺可能有關。[73][74] 呢啲因素對某啲高風險個體嘅影響可能比其他人更大。[72]

一年裏面嘅唔同時間亦可能影響自殺率。聖誕節前後似乎會少啲，[75] 但春天同夏天嘅比率會高啲，呢個可能同曬太陽有關。[35] 另一項研究發現，男性喺生日嗰日嘅風險可能更大。[76]

遺傳因素可能會影響自殺率。家族自殺史，尤其係阿媽嗰邊，對細路嘅影響大過青少年或成年人。[77] 領養研究顯示，呢個情況適用於有血緣關係嘅親屬，但唔適用於領養嘅親屬。呢樣嘢令到家族風險因素唔太可能係因為模仿造成。[35] 撇除精神障礙之後，估計自殺意念嘅遺傳度係 36%，而自殺未遂嘅遺傳度係 17%。[35] 對自殺嘅一個進化心理學解釋係，佢可能會提高整體適應度。如果自殺者冇得再生育更多後代，並且生存落去會消耗親屬嘅資源，就可能發生呢種情況。反對呢個解釋嘅一個理由係，健康青少年嘅死亡未必會提高整體適應度。對一個好唔同嘅祖先環境嘅適應，喺而家嘅環境可能係唔適應嘅。[78][79]

媒體

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睇埋：模仿自殺同社交媒體與自殺
 
喺歌德嘅《少年維特的煩惱》入面，主角因為涉及夏綠蒂（圖中喺佢墳前）嘅三角戀而自殺。一啲故事嘅仰慕者受到觸發而模仿自殺，呢個現象稱為「維特效應」。

包括互聯網在內嘅媒體扮演住重要角色。[58][77] 對自殺嘅某啲描寫可能會增加自殺嘅發生率，其中大量、顯眼、重複嘅報導，美化或浪漫化自殺嘅影響最大。[80] 例如，大約 15–40% 嘅人會留低遺書，[81] 而媒體被勸籲唔好報導遺書內容。 當詳細描述用特定方式自殺嘅方法時，呢種自殺方法可能會畀脆弱嘅人模仿。[20] 呢種現象喺幾次媒體報導之後都觀察到。[82][83] 為咗減少媒體描寫對自殺報導嘅負面影響，其中一個有效方法係教記者點樣報導自殺新聞，方式要能夠減少模仿嘅可能性，並鼓勵有風險嘅人尋求幫助。當記者遵循某啲報導指引時，自殺風險可以降低。[80] 不過，要得到媒體行業嘅認同同參與可能好難，尤其係長遠嚟講。[80]

呢種自殺傳染或模仿自殺嘅觸發稱為「維特效應」，個名嚟自歌德嘅《少年維特的煩惱》主角，佢自殺之後好多仰慕者都模仿佢。[84] 呢種風險喺可能將死亡浪漫化嘅青少年當中更大。[85] 似乎新聞媒體有顯著影響，但娛樂媒體嘅影響就唔確定。[86][87] 喺互聯網上搵自殺資訊同自殺風險有冇關，目前仲未清楚。[88] 維特效應嘅相反係提出嘅「帕帕基諾效應」，即係報導有效應對機制可能會有保護作用。呢個詞源於莫扎特歌劇《魔笛》中嘅一個角色——佢因為驚失去愛人而諗住自殺，直到朋友幫助佢先至冇事。[84] 因此，虛構作品描寫自殺，展示其他後果或負面後果，可能會產生預防效果，[89] 例如虛構作品可能將精神健康問題正常化，並鼓勵尋求幫助。[90]

身體狀況

編輯

自殺傾向同身體健康問題有關，例如[91] 慢性疼痛、[92] 創傷性腦損傷、[93] 癌症、[94] 慢性疲勞綜合症、[95] 腎衰竭（需要洗腎）、愛滋病同系統性紅斑狼瘡。[91] 癌症診斷大約會令之後嘅自殺頻率增加一倍。[94] 即使考慮咗抑鬱症同酗酒問題之後，自殺傾向增加嘅普遍性仍然存在。喺有多過一種身體狀況嘅人當中，頻率特別高。喺日本，健康問題被列為自殺嘅主要理由。[96]

睡眠問題，例如失眠[97] 同睡眠窒息症，係抑鬱同自殺嘅風險因素。喺某啲情況下，睡眠問題可能係獨立於抑鬱嘅風險因素。[98] 好多其他身體狀況可能會出現類似情緒障礙嘅症狀，包括甲狀腺功能減退症、阿茲海默症、腦瘤、系統性紅斑狼瘡，以及好多藥物（例如β受體阻斷劑同類固醇）嘅副作用。[16]

精神疾病

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自殺嗰陣有精神疾病嘅情況佔 27% 到超過 90%。[99][16][100][101] 喺因為自殺行為而入過醫院嘅人當中，終生自殺風險係 8.6%。[16][102] 相對嚟講，因為情緒障礙入過醫院但冇自殺行為嘅人，終生自殺風險係 4%。[102] 所有自殺死咗嘅人當中，有一半可能患有重度抑鬱症；患有呢種病或者其他情緒障礙（例如躁鬱症）會令自殺風險增加 20 倍。[103] 其他相關嘅狀況包括精神分裂症（14%）、人格障礙（8%），[104][105] 強迫症，[106] 同創傷後壓力症候群。[16]

其他人估計大約一半自殺身亡嘅人可以診斷出有人格障礙，其中以邊緣型人格障礙最常見。[107] 大約 5% 嘅精神分裂症患者死於自殺。[108] 飲食失調係另一個高風險狀況。[91] 大約 22% 到 50% 患有性別不安嘅人曾經嘗試自殺，不過呢個比例因地區而異好大。[109][110][111][112][113]

喺大約 80% 嘅自殺個案中，當事人喺死前一年內睇過醫生，[114] 其中 45% 係喺死前一個月內睇過。[115] 大約 25–40% 死於自殺嘅人喺死前一年內接觸過精神健康服務。[99][114] SSRI類嘅抗抑鬱藥似乎會增加細路同後生仔自殺嘅頻率。[116] 唔肯為精神健康問題去求助亦會增加風險。[66]

職業因素

編輯
睇埋：軍人自殺

某啲職業帶嚟較高嘅自殘同自殺風險，例如軍旅生涯。幾個國家嘅研究發現，尤其係退役軍人，[117][118][119][120] 特別係後生嘅退伍軍人，[121][122][117] 嘅自殺率明顯高過一般人口。 退伍軍人自殺風險較高，部分原因係同戰爭有關嘅精神疾病（例如創傷後壓力症候群）同身體健康問題嘅比率較高。[123]

過往嘗試

編輯

2002 年一份分析咗約 90 項自殺相關研究嘅回顧總結指出，曾經嘗試自殺或自殘之後，自殺風險比一般人高出幾百倍。[124] 一項比較近期嘅研究估計，有自殺未遂史嘅人，死於自殺嘅可能性大約係一般人嘅 25 倍。[125] 呢啲發現令自殺未遂成為最終完成自殺嘅其中一個最強預測因素。[16]

喺最終完成自殺嘅人群當中，估計有 25%（一年後）[124] 到 40%[126] 之前曾經嘗試過自殺。之後嘗試成功嘅可能性取決於用嘅方法、當事人嘅年齡同性別。[126] 其他風險因素例如藥物使用同精神健康狀況[125] 都會影響嘗試之後成功嘅可能性。過往嘗試時有強烈自殺意圖係另一個強烈嘅預測因素。[127]

距離上次嘗試嘅時間長短亦都扮演住關鍵角色。第一年同第二年完成自殺嘅風險最高。[124][125] 估計有 1% 嘅人喺第一次嘗試自殺後一年內死於自殺。[16] 估計大約 90% 嘅自殺倖存者最終唔會死於自殺。[128][91]

心理社會因素

編輯

好多心理因素會增加自殺風險，包括：絕望感、失去生活樂趣、抑鬱、焦慮、煩躁、思維僵化、反芻思考、思想壓抑，同埋應對技巧差。[103][77][129] 解決問題能力差、失去咗以前有嘅能力，同埋衝動控制差都有影響。[103][78] 對於老人家嚟講，覺得自己係其他人負擔呢種睇法好重要。[130] 從未結過婚嘅人風險亦都較高。[16] 近期嘅生活心理壓力，例如失去屋企人或朋友，或者失業，都可能係促成因素。[103][66]

某啲人格因素，尤其係高程度嘅神經質同內向，都同自殺有關。呢個可能會令啲孤僻同埋對痛苦承受力低嘅人更加容易嘗試自殺。[77] 另一方面，樂觀就被證明有保護作用。[77] 其他心理風險因素包括冇乜生存理由同埋覺得俾壓力情況困住咗。[77] 喺自殺狀態下，腦部嘅壓力反應系統可能會改變。[35] 具體嚟講，係多胺系統[131] 同下丘腦-垂體-腎上腺軸嘅變化。[132]


社會孤立同冇社會支持都同自殺風險增加有關。[77] 貧窮亦係一個因素，[133] 同周圍嘅人相比，相對貧窮程度提高會增加自殺風險。[134] 自 1997 年以嚟，印度農民自殺人數超過 20 萬，部分原因係債務問題。[135] 喺中國，農村地區嘅自殺可能性係城市地區嘅三倍，一般認為部分原因係呢個國家呢啲地區嘅經濟困難。[136]


有宗教信仰可能會降低一個人嘅自殺風險，而相信自殺係崇高嘅信念就可能會增加風險。[137][66][138] 呢個原因被認為係好多宗教對自殺持負面立場，以及宗教可能帶嚟更強嘅連繫感。[137] 喺有宗教信仰嘅人當中，穆斯林似乎有較低嘅自殺率；不過，支持呢個講法嘅數據唔係好強。[28] 自殺未遂率方面似乎冇分別。[28] 中東嘅年輕女性可能有較高嘅比率。[139]

理性

編輯
 
1945年5月日本神風特攻隊自殺式飛行員嘅少年新兵

理性自殺係經過深思熟慮攞自己條命嘅行為。[140] 不過，有啲人認為自殺從來都唔係理性嘅。[140]

安樂死同協助自殺喺好多國家，對於嗰啲生活質素差、冇可能好返嘅人嚟講，係俾人接受嘅做法。[141][142] 佢哋得到死亡權利嘅法律論證支持。[142]

為咗其他人嘅利益而攞自己條命嘅行為叫做利他主義自殺。[143] 一個例子係老人家結束生命，將更多食物留畀社區嘅後生仔。[143] 喺某啲因紐特文化入面，自殺被視為一種尊重、勇氣或智慧嘅行為。[144]

自殺式襲擊係一種政治或宗教行動，襲擊者對其他人施加暴力，並且明白咁做會導致自己死亡。[145] 有啲自殺式炸彈襲擊者嘅動機係渴望獲得殉道或者係出於宗教動機。[123] 神風特攻隊任務係作為對更高尚事業或道德義務嘅責任而執行嘅。[144] 謀殺後自殺係指實施殺人行為之後一個星期內，實施者自殺嘅行為。[146]

集體自殺通常係喺朋輩壓力下進行，成員將自主權交畀領袖（見下面著名案例）。[147] 集體自殺最少可以兩個人進行，通常叫做自殺協定。[148] 喺繼續生存會難以忍受嘅特殊情況下，有啲人用自殺作為逃避嘅方法。[149][150] 據知有啲納粹集中營嘅囚犯喺猶太人大屠殺期間，透過故意掂帶電圍欄自殺身亡。[151]

自殘

編輯

非自殺性自殘好普遍，有 18% 嘅人喺一生中會自殘。[152](p1) 自殘行為通常唔係自殺未遂，而且大多數自殘嘅人自殺風險唔高。[153] 不過，有啲自殘嘅人最終仍然會自殺身亡，自殘同自殺嘅風險可能會重疊。[153] 被確定為自殘之後入過醫院嘅人，死於自殺嘅可能性增加咗 Template:Estimate。[154](p279)

藥物濫用

編輯
 
《醉漢的進程》，1846年，展示酗酒點樣導致貧窮、犯罪，最終走向自殺

藥物濫用係繼重度抑鬱症同躁鬱症之後第二常見嘅自殺風險因素。[155] 長期藥物濫用同藥物中毒都有關連。[60][156] 如果再加上個人悲傷，例如喪親之痛，風險就更加高。[156] 藥物濫用亦同精神健康障礙有關。[60]


大多數人自殺身亡嗰陣都受到鎮靜劑（例如酒精或苯二氮䓬類藥物）影響，[157] 其中 15% 到 61% 嘅個案有酗酒問題。[60] 用處方苯二氮䓬類藥物同自殺及自殺未遂率增加有關。苯二氮䓬類藥物嘅促自殺效應被懷疑係由於副作用（例如去抑制作用）或戒斷症狀引起嘅精神困擾。[158] 酒精使用率較高同酒吧密度較大嘅國家，通常自殺率亦較高。[159] 曾經接受過酗酒治療嘅人當中，大約 2.2–3.4% 最終死於自殺。[159] 嘗試自殺嘅酗酒者通常係男性、年紀較大，並且以前曾經嘗試過自殺。[60] 海洛英使用者當中，有 3% 到 35% 嘅死亡係因為自殺（比非使用者大約高 14 倍）。[160] 喺濫用酒精嘅青少年當中，神經同心理功能失調可能會導致自殺風險增加。[161]


濫用可卡因同甲基安非他命同自殺有高度相關性。[60][162] 對於可卡因使用者嚟講，風險喺可卡因戒斷階段最高。[163] 吸入劑濫用者亦都有顯著風險，大約 20% 曾經嘗試自殺，超過 65% 考慮過自殺。[60] 食香煙同自殺風險有關。[164] 關於呢個關聯嘅原因，證據唔多；不過，有人推測天生容易食煙嘅人亦都天生容易自殺，食煙導致健康問題，繼而令人想結束生命，以及食煙影響腦部化學物質，導致自殺傾向。[164] 不過，大麻似乎唔會獨立增加風險。[60]

其他因素

編輯

創傷係細路[165] 同大人[77] 自殺傾向嘅風險因素。有啲人可能會為咗逃避欺凌或偏見而自殺。[166] 童年性虐待史[167] 同喺寄養家庭住過嘅經歷亦都係風險因素。[168] 性虐待被認為佔整體風險大約 20%。[65] 生命早期嘅重大逆境會對解決問題嘅能力同記憶力產生負面影響，呢兩樣都同自殺傾向有關。[35] 根據 2022 年嘅一項研究，童年不良經歷可能「同焦慮症、抑鬱症同自殺傾向嘅機率增加兩倍有關」。[169]

問題賭博同一般人相比，同自殺意念增加以及嘗試自殺有關。[170] 病態賭徒當中，有 12% 到 24% 會嘗試自殺。[171] 佢哋配偶嘅自殺率係一般人嘅三倍。[171] 其他增加問題賭徒風險嘅因素包括同時有精神疾病、酗酒同藥物濫用。[172]

感染寄生蟲弓漿蟲，更常見嘅叫法係弓蟲症，都同自殺風險有關。一種解釋話，呢個係由免疫反應引起嘅神經傳遞素活動改變所致。[35]

方式

編輯

自殺嘅方式有好多種，以下淨係列出常見嘅方式：

參考

編輯
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